中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2012年
3期
154-157
,共4页
谈颂%常思远%宋波%高远%卢甲盟%许予明
談頌%常思遠%宋波%高遠%盧甲盟%許予明
담송%상사원%송파%고원%로갑맹%허여명
卒中%脑缺血%预后%疾病严重程度指数%预测
卒中%腦缺血%預後%疾病嚴重程度指數%預測
졸중%뇌결혈%예후%질병엄중정도지수%예측
Stroke%Brain ischemia%Prognosis%Severity of illness index%Forecasting
目的 探索卒中发生早期不同时间段改良美国国立卫生研究院卒中量表(mNIHSS)评分对缺血性卒中后6个月预后的预测价值.方法 收集前循环缺血性卒中病例并记录卒中发生后3d内、4～6d、7～9d的mNIHSS评分及卒中后6个月的改良Rankin评分(mRS).使用Spearman秩相关系数及受试者工作特征(ROC)曲线进行统计学分析.结果 共收集161例患者.发病3d内、4～6d、7～9d的mNIHSS评分和卒中后6个月时的mRS评分呈正相关,相关系数r3分别为0.592、0.597、0.595,均P＜0.01.发病6个月时曲线下面积(AUC)在卒中后3d内、4～6d、7～9d分别为0.789(95％CI0.708 ～0.856)、0.792(95％CI0.712 ～0.857)、0.799(95％ CI0.721 ～0.864).发病6个月时不同时间段AUC两两比较,3d内和4～6 d(z =0.93,P=0.14)、3d内和7～9 d(z=0.94,P=0.52)、4～6d和7～9 d(z =0.96,P=0.27)差异无统计学意义.预测6个月预后的最佳界值在3d内、4～6d和7～9d分别为8、7和6分.在相应时间段评估mNIHSS时高于最佳界值则预后不良,低于或等于最佳界值则预后良好.不同时间段mNIHSS预测卒中6个月预后的阴性预测值由3d内的0.847渐增至第7～9天的0.867,而阳性预测值由3d内的0.601渐减至第7～9天的0.533.总体的一致率由3d内的0.753渐减至第7～9天的0.709.结论 卒中发生9d内mNIHSS评分对卒中6个月预后有良好的预测价值.但在卒中早期的不同时间段使用mNIHSS评分预测6个月预后的最佳界值不同.
目的 探索卒中髮生早期不同時間段改良美國國立衛生研究院卒中量錶(mNIHSS)評分對缺血性卒中後6箇月預後的預測價值.方法 收集前循環缺血性卒中病例併記錄卒中髮生後3d內、4～6d、7～9d的mNIHSS評分及卒中後6箇月的改良Rankin評分(mRS).使用Spearman秩相關繫數及受試者工作特徵(ROC)麯線進行統計學分析.結果 共收集161例患者.髮病3d內、4～6d、7～9d的mNIHSS評分和卒中後6箇月時的mRS評分呈正相關,相關繫數r3分彆為0.592、0.597、0.595,均P＜0.01.髮病6箇月時麯線下麵積(AUC)在卒中後3d內、4～6d、7～9d分彆為0.789(95％CI0.708 ～0.856)、0.792(95％CI0.712 ～0.857)、0.799(95％ CI0.721 ～0.864).髮病6箇月時不同時間段AUC兩兩比較,3d內和4～6 d(z =0.93,P=0.14)、3d內和7～9 d(z=0.94,P=0.52)、4～6d和7～9 d(z =0.96,P=0.27)差異無統計學意義.預測6箇月預後的最佳界值在3d內、4～6d和7～9d分彆為8、7和6分.在相應時間段評估mNIHSS時高于最佳界值則預後不良,低于或等于最佳界值則預後良好.不同時間段mNIHSS預測卒中6箇月預後的陰性預測值由3d內的0.847漸增至第7～9天的0.867,而暘性預測值由3d內的0.601漸減至第7～9天的0.533.總體的一緻率由3d內的0.753漸減至第7～9天的0.709.結論 卒中髮生9d內mNIHSS評分對卒中6箇月預後有良好的預測價值.但在卒中早期的不同時間段使用mNIHSS評分預測6箇月預後的最佳界值不同.
목적 탐색졸중발생조기불동시간단개량미국국립위생연구원졸중량표(mNIHSS)평분대결혈성졸중후6개월예후적예측개치.방법 수집전순배결혈성졸중병례병기록졸중발생후3d내、4～6d、7～9d적mNIHSS평분급졸중후6개월적개량Rankin평분(mRS).사용Spearman질상관계수급수시자공작특정(ROC)곡선진행통계학분석.결과 공수집161례환자.발병3d내、4～6d、7～9d적mNIHSS평분화졸중후6개월시적mRS평분정정상관,상관계수r3분별위0.592、0.597、0.595,균P＜0.01.발병6개월시곡선하면적(AUC)재졸중후3d내、4～6d、7～9d분별위0.789(95％CI0.708 ～0.856)、0.792(95％CI0.712 ～0.857)、0.799(95％ CI0.721 ～0.864).발병6개월시불동시간단AUC량량비교,3d내화4～6 d(z =0.93,P=0.14)、3d내화7～9 d(z=0.94,P=0.52)、4～6d화7～9 d(z =0.96,P=0.27)차이무통계학의의.예측6개월예후적최가계치재3d내、4～6d화7～9d분별위8、7화6분.재상응시간단평고mNIHSS시고우최가계치칙예후불량,저우혹등우최가계치칙예후량호.불동시간단mNIHSS예측졸중6개월예후적음성예측치유3d내적0.847점증지제7～9천적0.867,이양성예측치유3d내적0.601점감지제7～9천적0.533.총체적일치솔유3d내적0.753점감지제7～9천적0.709.결론 졸중발생9d내mNIHSS평분대졸중6개월예후유량호적예측개치.단재졸중조기적불동시간단사용mNIHSS평분예측6개월예후적최가계치불동.
Objective To investigate the predictive value of the modified National Institutes of Health Stroke Scale ( mNIHSS),measured within 9 days after stroke,for the outcome in terms of modified Rankin Scale (mRS) at 6 months after stroke.Methods AII 161 patients with acute anterior circulation ischemic stroke were recruited consecutively from July 2010 until November 2010.The mNIHSS score was assessed within 3 days,4 to 6 days and 7 to 9 days after stroke,and the mRS score at 6 months after stroke was assessed by a neurology resident.Spearman rank correlation and ROC curve were used for statistic analysis.Results One hundred and sixty-one patients were assessed within 3 days,at 4 to 6 days and 7 to 9 days after stroke.Significant Spearman rank correlation coefficients were found between mRS at 6 months and mNIHSS scores within 3 days (rs =0.592,P＜0.01 ),4 to 6 days (rs =0.597,P＜0.01 ) and 7 to 9days (rs =0.595,P＜0.01).At 6 months after stroke,the AUC ranged from 0.789 (95％ CI 0.708-0.856) for measurements within 3 days to 0.792 (95％ CI 0.712-0.857 ) and 0.799 ( 95％ CI 0.721-0.864) for 4 to 6 days and 7 to 9 days,respectively. There was no significant difference for the AUCbetween them.The optimal cut-off values for the prediction of prognosis at 6 months were 8,7 and 6 points of mNIHSS score within 3 days,4 to 6 days and 7 to 9 days,respectively.The negative predictive value gradually increased from 0.847 for assessment within 3 days to 0.867 ( 95％ CI 0.578-0.765 ) for 7 to 9 days,whereas positive predictive value declined from 0.601 for assessment within 3 days to 0.533 for 7 to 9 days.The overall accuracy of predtictions decreased from 0.753 for assessment within 3 days to 0.709 for 7 to 9 days.Conclusions When measured within 9 days,the mNIHSS has a good predictive value for final outcome in terms of mRS at 6 months after stroke.However,the optimal cut-off values for the prediction of prognosis at 6 months are different when early mNIHSS scores were assessed at different periods.
